MARCH's young investigators tackle infectious diseases in Myanmar

The now well-established Myanmar-Australia Research Collaboration for Health, or MARCH, aims to improve the management of infectious diseases in Myanmar. The collaboration has a particular focus on encouraging young local clinicians to perform research that addresses the problems that they encounter every day in Myanmar’s under-resourced public health system.

Senior MARCH clinicians Professor Mar Mar Kyi and Dr Ne Myo Aung, have been collaborating with researchers from the Kirby Institute since 2013, examining diseases as diverse as malaria, HIV and rabies. Now, a group of young Myanmar clinicians is addressing a variety of new infections, with the support of Professor Mar Mar Kyi and Dr Ne Myo Aung, along with researchers from the Kirby Institute.

In Myanmar, up to 30% of patients with central nervous system infections will die, but with limited local diagnostic support it is frequently unclear what is causing these infections. Dr Thin Zar Cho Oo – with the support of the MARCH research laboratory – is examining this issue in a study which is expected to inform local management strategies.

Gastric cancer and stomach ulcers together cause more deaths in Myanmar than HIV/AIDS. The main cause of both diseases is infection with Helicobacter pylori, a bacterium than infects up to 50% of the Myanmar population. The high rates of antibiotic resistance in the country means that we don’t know the best combination of antibiotics to cure this infection. Dr Nan Phyu Sin Toe Myint is examining the efficacy of different treatment approaches and her results are expected in early 2019.

Myanmar has one of the highest burdens of tuberculosis in the world. In 2017, it is estimated that there were 191,000 patients diagnosed with the infection, of whom 27,000 died. The sheer volume of cases sometimes threatens to overwhelm the health service. Dr Ne Lin Tun is examining how to identify patients at greatest risk of deterioration, ensuring that they can be followed up more closely and ultimately improving survival.

Sepsis is the most common cause of death on Myanmar’s hospital wards. Dr Kyi Lai Ye Lynn has recently completed her master’s thesis on the subject, which will be published in The Transactions of the Royal Society of Tropical Medicine and Hygiene in the coming weeks. Her study demonstrated that the burden of multi-drug resistant organisms and the lack of diagnostic facilities translated into a case-fatality rate of almost 30%. Strategies to address these issues were also outlined.

Dr Josh Hanson, the Kirby Institute’s project lead for MARCH, is impressed by the talent and application of the young clinicians. “These young clinicians have always known what to do, they just haven’t had the resources to do it,” says Dr Hanson. “Work from the master’s project of Dr Phyo Pyae Nyein was presented at the Malaria World Congress in July and is expected to inform management of adults with the disease globally. If this were to happen in Australia it would be headline news.”

Professor Mar Mar Kyi shares Dr Hanson’s enthusiasm. “We are excited to see how the lessons that we have learned from our research are improving the care of our patients,” she says, “and we have only just begun”.

Professor Mar Mar Kyi teaches her team on a ward round at Insein General Hospital.

Dr Thin Zar Cho Oo (right) supervises a lumbar puncture performed by Dr Kyi Nyein Yin, one of the MARCH research officers.

Dr Nan Phyu Sin Toe Myint (centre) interviews a patient with the support of MARCH research officer Dr Kyauk Sain.